Provider Demographics
NPI:1790373660
Name:WALLACE, ERIN STEHLE (CCC-SLP, PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:STEHLE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:CCC-SLP, PHD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEEE
Other - Last Name:STEHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4710 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3136
Mailing Address - Country:US
Mailing Address - Phone:804-385-8487
Mailing Address - Fax:
Practice Address - Street 1:315 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1293
Practice Address - Country:US
Practice Address - Phone:434-395-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist